Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors

a retrospective cohort study

Obiageri O. Obodozie-Ofoegbu, Chengwen Teng, Eric M. Mortensen, Chris Frei

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.

    Original languageEnglish (US)
    JournalAmerican Journal of Infection Control
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Pneumonia
    Cohort Studies
    Retrospective Studies
    Odds Ratio
    Confidence Intervals
    Therapeutics
    Mortality
    Veterans Health
    United States Department of Veterans Affairs
    Pseudomonas
    Guidelines
    Anti-Bacterial Agents
    Pharmaceutical Preparations
    Population

    Keywords

    • Antibiotics
    • Mortality
    • Pseudomonas
    • Risk score
    • Survival

    ASJC Scopus subject areas

    • Epidemiology
    • Health Policy
    • Public Health, Environmental and Occupational Health
    • Infectious Diseases

    Cite this

    Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors : a retrospective cohort study. / Obodozie-Ofoegbu, Obiageri O.; Teng, Chengwen; Mortensen, Eric M.; Frei, Chris.

    In: American Journal of Infection Control, 01.01.2019.

    Research output: Contribution to journalArticle

    @article{3802d69ac6464fddafece6e18f315e22,
    title = "Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study",
    abstract = "Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18{\%} vs 8{\%}), followed by the medium-risk group (24{\%} vs 18{\%}) and then the high-risk group (39{\%} vs 33{\%}). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95{\%} confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95{\%} CI, 1.50-1.89), medium (aOR, 1.30; 95{\%} CI, 1.14-1.48), and high (aOR, 1.21; 95{\%} CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.",
    keywords = "Antibiotics, Mortality, Pseudomonas, Risk score, Survival",
    author = "Obodozie-Ofoegbu, {Obiageri O.} and Chengwen Teng and Mortensen, {Eric M.} and Chris Frei",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1016/j.ajic.2019.02.018",
    language = "English (US)",
    journal = "American Journal of Infection Control",
    issn = "0196-6553",
    publisher = "Mosby Inc.",

    }

    TY - JOUR

    T1 - Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors

    T2 - a retrospective cohort study

    AU - Obodozie-Ofoegbu, Obiageri O.

    AU - Teng, Chengwen

    AU - Mortensen, Eric M.

    AU - Frei, Chris

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.

    AB - Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.

    KW - Antibiotics

    KW - Mortality

    KW - Pseudomonas

    KW - Risk score

    KW - Survival

    UR - http://www.scopus.com/inward/record.url?scp=85063100124&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85063100124&partnerID=8YFLogxK

    U2 - 10.1016/j.ajic.2019.02.018

    DO - 10.1016/j.ajic.2019.02.018

    M3 - Article

    JO - American Journal of Infection Control

    JF - American Journal of Infection Control

    SN - 0196-6553

    ER -